Kymberly Smith had had sufficient. It was February 2020, and she or he was grieving the sudden loss of life of her husband when Covid lockdowns started. She was alone, with none entry to her help community, and she or he was “within the throes of menopause.”
Finally, Ms. Smith, 57, began utilizing antidepressants for her grief. She was additionally on hormone remedy to ease her fixed scorching flashes and disruptive evening sweats. However when it got here to the 20 kilos she had gained, round her stomach, she “simply couldn’t shake it away.”
That weight acquire, she stated, is tough to untangle from her circumstances — it may need been attributable to the antidepressants or by the fluctuations in hormone ranges throughout menopause. Nevertheless it made her really feel like she had no management over her life and physique. “You lose your self,” she stated. “You’re feeling just a little bit helpless.”
This previous April, Ms. Smith began utilizing Wegovy, the load loss drug that, together with the diabetes drug Ozempic and others prefer it, has soared in reputation. She has since misplaced about 35 kilos.
Ladies going by way of menopause elevate issues about weight and physique modifications nearly as typically as they do about scorching flashes and evening sweats, stated Dr. Stephanie Faubion, medical director for the Menopause Society and a director of the Mayo Clinic’s Middle for Ladies’s Well being. “They arrive in, they usually’re typically in tears about it. They don’t know what’s occurring,” she stated. Some estimates recommend that roughly 70 percent of ladies acquire as much as 1.5 kilos per yr throughout the menopause transition, which can last as long as a decade.
This weight acquire can have an effect on ladies’s vanity and high quality of life and may also improve the chance of diabetes, heart problems and different well being points. Extra weight can be correlated with more scorching flashes and evening sweats; the Menopause Society recommends weight loss as an efficient nonhormonal remedy for these signs.
Now, some ladies going by way of menopause are searching for medication like Ozempic, regardless of the steep prices: With out insurance coverage protection, the medication can run round $1,000 a month. “We’re getting requests each day,” Dr. Faubion stated.
And a few docs are starting to oblige. Given the prevalence of weight problems in america, “a majority of midlife ladies really meet the factors to obtain these medicines,” stated Dr. Daniela Hurtado, an assistant professor of medication, endocrinologist and weight problems medication specialist on the Mayo Clinic.
Consultants fear that these medicines — that are comparatively new, and whose long-term results are nonetheless being studied — might exacerbate the lack of muscle mass and bone density already common among menopausal women, doubtlessly placing them at better danger for fractures, falls and osteoporosis.
“That could be a concern to me, positively,” stated Dr. Scott Hagan, an assistant professor of medication on the College of Washington who research weight problems.
‘You simply wrestle and wrestle’
Some menopausal weight acquire is most certainly attributable to the slowdown in metabolism that occurs as we age, Dr. Hurtado stated. Menopause signs like insomnia and evening sweats may additionally result in weight modifications, as a result of ladies could also be “drained and fewer prone to train,” she stated. And hormonal modifications throughout menopause shift how and where fat is stored in the body, with ladies usually gaining extra fats across the midsection whereas additionally losing muscle total.
“The actual fact of the matter is that for plenty of adults, however notably menopausal ladies, these hormonal modifications make it extraordinarily tough to shed some pounds it doesn’t matter what you’re doing,” stated Dr. Elaine Eustis, a gynecologist whose South Carolina apply focuses on menopause care.
Since opening her clinic in March 2022, Dr. Eustis has handled 1,500 sufferers, 150 of whom are actually taking some type of semaglutide, the substance in Ozempic and Wegovy. Semaglutide simulates a hormone that our our bodies naturally produce, making individuals really feel full over longer durations of time. The drug additionally targets the areas of the mind that regulate urge for food, main many sufferers to report that their “food noise,” or psychological chatter round consuming, fades away.
Karen Smith, 60 (no relation to Kymberly), knew, as a nurse, that she would doubtless acquire weight throughout menopause. However she wasn’t ready for simply how onerous it might be to lose that weight.
She minimize out bread and meat and piled her plate with greens. She tried yoga and weight lifting and walked her canine two miles every day. Nothing labored. “You simply wrestle and wrestle,” she stated.
As a result of these medication are permitted just for sure teams (Ozempic and Mounjaro for these with diabetes, Wegovy and Zepbound for individuals with weight problems or who’re chubby with sure well being circumstances), many individuals find yourself paying out of pocket for the treatment. Ms. Smith sought out a telehealth clinic that might prescribe compounded semaglutide, which is less expensive than a brand-name drug. The Meals and Drug Administration has warned shoppers about these unauthorized medications, citing potential security dangers and a scarcity of oversight.
Nonetheless, Ms. Smith needed the treatment. She misplaced 30 kilos in her first 5 months on the drug.
“It’s been the one factor that has ever labored,” she stated.
An advanced calculus
Any weight reduction usually results in muscle loss, and amongst menopausal and postmenopausal ladies, shedding a major quantity of muscle mass can raise the risk of becoming frail, Dr. Hagan stated.
Estrogen loss throughout menopause accelerates bone loss, placing ladies at an elevated danger for fractures and osteoporosis, Dr. Hurtado stated, so including semaglutide to the combo may presumably worsen the issue as a result of vital, fast weight reduction may also doubtlessly result in bone density loss. Research have discovered that hormone therapy helps forestall bone loss throughout menopause, although not all ladies wish to or can use this feature. It’s important that menopausal ladies who’re taking medicines for weight reduction do energy coaching and eat plenty of protein, she stated, to construct muscle that may assist counteract the consequences of bone loss.
“I don’t need them to grow to be so frail that they will fall within the winter and break a hip,” stated Dr. Hurtado, who displays her menopausal sufferers on semaglutide for modifications in bone density and muscle mass.
There are additionally potential unintended effects — together with nausea, vomiting and constipation — for sufferers of any age who’re on Ozempic and comparable medication, particularly as individuals improve their doses. In uncommon circumstances, the medication can put individuals in danger for an infected pancreas, or suppress urge for food a lot that they eat dangerously few nutrients.
However many menopausal ladies are prepared to take the gamble. And for some, the trickiest a part of taking the medication is the onerous questions raised about what they’re prepared to do to shed some pounds, and why they really feel so strongly about it.
When Johanna Winter-Harper gained almost 60 kilos in perimenopause, she tried to embrace the concept of body neutrality.
“I needed to like myself as I used to be,” stated Ms. Winter-Harper, 51, who’s a therapist in Chicago.
However she nervous that the added weight harmed her well being. She has a household historical past of coronary heart illness and diabetes and was alarmed when her blood sugar rose to the extent of pre-diabetes. When she couldn’t lose the load after exercising extra and adjusting her food plan — extra protein, fewer carbohydrates, heaps of fruit and greens — she determined to attempt Ozempic.
She has misplaced 50 kilos within the final yr on the treatment, and her ldl cholesterol and blood sugar ranges have fallen. Nonetheless, she stated, she felt conflicted.
“I embraced myself as much as a sure level, after which sure, there was well being,” she stated. “However once I’m actually sincere about it, I needed to be thinner, too.”
